Study on quality control of mediastinal shift radiotherapy with target volume after operation for non-small cell lung cancer
10.3760/cma.j.cn113030-20211026-00432
- VernacularTitle:非小细胞肺癌术后放射治疗纵隔移位研究
- Author:
Wei ZHANG
1
;
Yi ZHANG
;
Wei HONG
;
Weiwei OUYANG
;
Shengfa SU
;
Zhu MA
;
Qingsong LI
;
Wengang YANG
;
Xiaxia CHEN
;
Jie LIU
;
Bing LU
Author Information
1. 贵州医科大学附属医院/贵州医科大学附属肿瘤医院肿瘤科，贵阳 550004
- Keywords:
Mediastinal displacement;
Carcinoma, non-small cell lung/postoperative radiotherapy;
Quality assurance;
Quality control
- From:
Chinese Journal of Radiation Oncology
2022;31(3):242-247
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the mediastinal displacement of target volume in the postoperative radiotherapy (PORT) process for non-small cell lung cancer (NSCLC) and the value of mid-term evaluation.Methods:For 100 patients with postoperativeN 2 stage NSCLC, R 1-2 and any N staging, bone anatomy was utilized to measure the change of the first and second CT localization on the same level. Statistical analysis were performed using the WilCoxon, Kruskal-Wallis and χ2 tests. The cut-off values were calculated with the receiver operating characteristic (ROC) curve. Results:Among the included patients, in the PORT process, the mediastinal displacement in the x (front and rear), Y (left and right) and Z (upper and lower) directions were 0.04-0.53 cm, 0.00-0.84 cm and 0.00-1.27 cm, respectively, and the order of mediastinal displacement distance wasz > Y> X,respectively. According to the ROC curve calculation, the cut-off values were 0.263, 0.352 and 0.405, respectively, which were greater than the cut-off values in 25 cases (25%), 30 cases (30%) and 30 cases (30%), respectively. There was significant difference in the three-dimensionalmediastinal displacement ( P=0.007, <0.001 and<0.001). The mediastinal displacement in thex, Y and Z directions had no statistical significance regarding resection site ( P=0.355, 0.239 and 0.256) and operation mode ( P=0.241, 0.110 and 0.064). Comparative analysis of modified whole group mediastinal shift> and cut-off values, medium-simulation (m-S) and the originally planned radiotherapy shown that there was no significant difference in the incidence of radiation esophagitis (RE) and radiation pneumonitis in PORT patients (all P>0.05); however, the incidence of ≥grade 3 RE in the modified plan after m-S was significantly lower than that in the originally planned PORT patients, which were 0 and 7%, respectively ( P<0.001). Conclusions:Mediastinal displacement exists in the PORT process of N 2 or/and R 1-2 cases after radical operation of NSCLC, and obvious movement occurs in 20%-30% of patients. Relocating and modifying the target volume and radiotherapy plan in the middle of the PORT process is beneficial to quality assurance and quality control.
